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HomeMy WebLinkAbout17143-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 217224 Date AUGUST 24, 1988 THI5 CERTIFIES that the building ACCESSORY Location of Property 1790 DEIDRICKS ROAD PVT RD #7 ORIENT House No. Street Hamlet County Tax Map No. 1000 Section 18 Block 03 Lot OS Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 10, 1988 pursuant to which Building Permit No. 171432 dated JUNE 21, 1988 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued isACCESSORY TOQL SHED AS-APPLIED FOR. The certificate is issued to DOROTHY I. ABBOTT-JANET T. SWANSON (owner, xxxxxxxxxxxxxxxx) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A G ~ 6,~-~~ Building In pector Rev. 1/81 n~osas xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N o 01714 3 Z Date .G~~:~........~:..~ 19~~ Permission is hereby grante to: yam-- ......i°...U...l.~.. ......7.. s'.~~..r~.. to .lLl.,........,.n~,~.r..-.!:....I.ill...!-.~.1,........:4~........................ ...........o<,~~~,..~:~ ~o . at premises located at ...L.. j........... ~~~`~j/••/•• ......~r..:.~..,..................................................... ......................................................................,~yy................................... Caunty Tax Map No. 1000 Section .....~..G.?........... BQlock L©ot No.....y7 pursuant to application dated .G/~ZIGY.ttr.G,........f% 19~~J and approved by the Building Ins~pe-ctor. Fee $...p~..J...~..~i..~ .,,~~,r~!!T!~1!~~l.Z.......~......y~~r7f~........~.~...... Building Inspector Rev. 6/30/80 i D c~ c~~.l FORM NO. 6 ' TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 Bi-Dt' pef`T• 765 - 1802 TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted •s~.~~ to the Building Inspec- torwith the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. Z. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, acertificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of prnperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.OOALTERATION $25.00 ' 1. Certificate of occupancy New Dwelling, $25.00, Accessory ]0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00 , over 5 years $ 1 0 .00 . 4.Vacant Land C.O. $ 20.00 ~~,,y~~~~- s.unaatea c.o. $ so.oo Date ..G""Y~"'".~?.y..1.4&k.... New ConstructTo6n $)}CD OId orPre-existing Building Vacant Land P~.~1 Location of Property .L?9o ,..~~t:~(~=,;,,,L~,,,,, bQf~~,n(y...~?C~'.~~.. House No. Street Hamlet Owner or Owners of Property ~.°.~.~1~".1.. , go~ ~ - : ~tJ fl N'sp~ County Tax Map No. 1000 Section Q Block 3........... Lot 5 . Subdivision . .......Filed Map No+. ..........Lot No. . . PermitNo.~~.~.1~3 z. Date of Permit 6~2~/.Applicant. J!r~„E',C,,,T~, ~~1;/,~-Sp-~..... Health Dept. Approval ........................Labor Dept. Approval . Underwriters Approval ........................Planning Board Approval . Request for TempGo/rary Certificate .....................Final Certificate Y................... . Fee Submitted $ . f a•. t~v . . Construction on above described building and ermit meets all applicable codes and regulations. Applicant . n~ ....~&L~, . Rev. 70-10.78 I 3 S SG S c'lELD II:SPEC; IU:Ji t ~~UATE ~ ~OhfMENT° ~ ~ `~°Vh 1 . 3 _ _ _ _ FOUtJDATION (1st) m FOUNDATIOtJ (2nd) 2. z+ o~ P,OUGH FRAME & ~ 4 .PLUMBING ~J ti H 3. ra ca y ItJSULATIOP! PER N. Y. STATE ENERGY CODE Q m a ~ f a~a~,,, ~ ..-.I y 4. ~ F I iJ A~ ox.. -b~ o z ADDI NAL COMMENTS: x ca ~ x~ ~n H~ H O~p V2 J C+J b r H _ ~ d m ro H a 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING ~INAL REMARKS: //Q~ l~~ `~r ~ DA'C'E ~ I J ~ INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ni=r.:1 3 i)O(J ~'t ~ BUREAU OF ELECTRIGITV 83 JOHN STREET, NEW YORK, NEW YORK 10038 Date i7UInY' 7'f, 1A;;4 Application No. on file f~~~7liS ~1f$`~7 It l)a~i)'t:~Y~ THIS CERTIFIES THAT only the electrical equipment as described 6ebu+and introduced 6y the applicant named on the above application number in the premises of ]sl;~dt)=h~tYr ;:ri~nr=hr Ir~,~afrx~tr;r~ ~r,, (~llti,i;'~'I'< ~,v. in thefalfowinq location; ? Basement ® lat Fl. ? 2nd Fl. ;iT?71'}I[) Section Block Lot uws examined an cj911VP` '"fl r i t)~~~ and found to 6e in coneplianre uifh the reyuireneents of this Baard. FIXTURE ECEPTACLE$ SWITCHES FIXTURES RANGES COOKING DECK$ OVENS DISH WASHERS EXHAUST FANS OpUTIET$ 1ti INCANDESCENT FLUORESCENT OTHER AMT K W. AMT. K W PMi KW pMi K W AMT. H P :J t.l ~i 1, ~)Y,~( i t` DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS AMT. K. W. Oll H. P. GAS H. P AMT. NO. A W. G. AMT AMP. AMT. AMPS TRANS. AMT. H. P SYSTEMS qMi. WAiiS NO.OF FEET ?Y tiGt) SERVICE DISCONNECT NO.OF 5 E R V I C E AMT. AMP, TYPE METER I s' 9W 1 q 3W J.a 3W 3,e' dW NO OF CC COND A W G. A W. G. A W. G. EQUIF. PER d OF CC COND. NO.OF HI-LEG Of MLIEG ~ OF NEUTRALS OF NEUTRAL OTHER APPARATUS: tprtarr, ol,i»7 ~,z'~stal~;x a PniVE:Lt3i)ARLIl~.Y-"~ t'tCt. 1(ftl i;.Y''.t'"„'.~ i 9'lr~ia< i',i(rfl'P'I'P5Cr'= ft KN.THiJR fi~ I'ttY124~:DF~ IeLf`..~~;~;~rd°!; f?AI'N ROAI'r OH 7 isN7~ _ F(~~ = f 1 ~ GENERAL MANAGER Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be idenf'rfi~d by fte credentials. COPY F.OR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST N07 BE ALTERED IN ANY MANNER. ~/~~y~(L~I~~`F'~l~ BOARD OF HEALTHl z°".'""..`";,,e.....~ i i I I 3 SETS O F PLANS • . 4 't FORM NO. 7 SURVEY I OI986 i~ TOWN OF SOUTHOLD CHECK . 6UILDING DEPARTMENT SEPTIC FORM -°"t?s.~G~i:i~ s" , _ TOWN HALL TOVJivtOP50=!~;~°" SOUTHOLD,N.Y.11971 NOTIFY ,d,.a ~,..r.... ~ . TEL.: 765-1802 ~/I- hh ~~JJ CALL Exantine~~~. •o`:~.., 190 MAIL T0: Approve/~~Lya.*C..p?•~...., 19Q~j Permit No.(~ L.~~ .y~.e_, Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT ~p~ Date ~tit~.~ . 19~. Tdo~ <jl~'~-U INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate piot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been gr~ttted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins ections. (Sig ature of applicant, or name, if a corporatton) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. tp . OW»Cr Name of owner of premises ~ore~ln,q ..~.•.:~ty~ot~~..~..~a:'!?:(:T.-..~!,as:~..ts.h •11 (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No . . Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed work will be done. 7 --nom^,~ a¢l~Yl~ S y ©r~G.~F, Ilri S;7 .......1..79d........ I{ouse Number ~ Street Hamlet County Tax Map No. 1000 Section ~ ~ g Block , .3. , , , , , , , , , , Lot . Subdivision Filed blap No. Lot . (Name) Z. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . b. Intended use and occupancy •S•~-~ • • • • • • • • • . t w 3 Repair of work (check which (applicable): New Building • • • • • , Addition Alteration , Removal Demolition `~r~lile~~5~o~i,,....... (Description) 4. Estimated Cost ~ ~~OO.t~"', . Fee ~arv.'~ d......................... . (to be paid on filing this application) g g ~ n g units . , Number of dwelling units on each floor , , , , , , , , , , , , • • 5. If darallennumbeb of cadsvelliri', . • . • , • • • . • • • • • 6. If business, commercial or mixed occupancy, specify nature and extent of each•type of use . Height s.... Nures, if any: Front-.."a:.:, Rear i Depth . . . Dimensions of existin structumber of Stories . . Dimensions of same structure lvith alterations or additions: Front • Rear ept g Ilcight y Number of Stories . Hemhtst lO ~r~„fire~ w construction: Front , . ,1~, , , , , ~ > • " " r Rear ..1.Z.......... Depth . u~nberof-SCories~,.~ ~ ~ - 9. Size of lot: Front . P, Rear :.y'3.~ th 20pc^~ 10. Date of Purchase ...l.`I$.$ , , , , , , , , , , , , , , , , , , ,Name of Former Owner ?14rWradq,4 i ~Owco~efewa~ . , , 13. Will lot ba rea aded in whiclto}emises are situated . ,1~ev1c(ea.;(x,,p, • • , , . • • • . 12. Does proposed construction viglate any zoning law, ordinance or regulation: . M.4 ..Will excessp fill be removed from premises: Yes ~J 14. Name of Owner of premises~ermbo'I~yJ,s,y~,µc,,Q.y, ,Address f70X. •,?,S,7,r7rt~, Phone No. X23 33:6,{0, . ,Name of Architect r' ,Address . !19S e r 7. Phone No. ,7,3~ •S~gf~ , Name of Contractor ~ ~t`4~,~j.4'*4~ . .Address . ,Phone No. . . 15.Is this property located within 100 feet of a tid~wetland? *YES....N0.7~,.. *If yes, Southold Town Trustees Permit may be required. I PLOT DIAGRAM Locate clearly and distinctly alb buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. n_ _ ~SC S¢a- q.•~4-aoke~Q _ C'~rclWa l J- Starury Ii i i I! I STATE OF NEW YORK, COUN"fY OF $.S (Name of individual si~ni ' • ' ' ' ' ' • • • being duly sworn, deposes and says that he is the applicant above named. _ {~S contract) He is the (Contractor, agent, corporate officer, etc.) ~ ~ ~ • of said owner or owners, and is duly] authorized to perform or have performed the said work and to make and file this application; that all statements contai;hed in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner'set forth in the application filed therewith. Sworn to before me this ~ U ~ . .day of _ 19F1•~ Notary Public, , .VIi~Q;~, , County ~p~,~ HELEN R DE VOE . NOTARY PUBLIC, Stets of Npw York Ne. 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